THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO YOUR CHILD’S INFORMATION. PLEASE REVIEW CAREFULLY.
We are required by law to:
- maintain the privacy of your child’s protected health information
- provide to you this detailed Notice of our legal duties and privacy relating to your child’s personal health information; and
- abide by the terms of the Notice that are currently in effect
1. WE MAY USE AND DISCLOSE YOUR CHILD’S PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
As part of the admission process, you will be asked to sign a consent allowing us to use and disclose your child’s protected health information for purposes of treatment, payment, and health care operations. We require this consent as a condition of providing treatment because the uses and disclosures are essential to our ability to care for your child. We have described these uses and disclosures below and provided examples.
For Treatment: We will use and disclose your child’s protected health information in providing your child with treatment and services. We may disclose your child’s protected health information to facility and non-facility personnel who may be involved in your child’s care, such as physicians, nurses, nurse aides, rehabilitation therapists, and consultants. For example, a nurse caring for your child will report any changes in your child’s condition to the doctor. We may also disclose protected health information to individuals who will be involved in your child’s care after your child is discharged from Elizabeth Seton Children’s.
For Payment: We may use and disclose your child’s protected health information so that we can bill and receive payment for the treatment and services your child receives at the facility. For billing and payment purposes, we may disclose your child’s protected health information to an insurance or managed care company, Medicaid, or another third party payer. For example, we may contact Medicaid or your health plan to confirm your child’s coverage or to request prior approval for a proposed treatment or service.
For Health Care Operations: We may use and disclose your child’s protected health information for facility operations. These uses and disclosures are necessary to manage the facility and to monitor our quality of care. For example, we may use protected health information to evaluate our facility’s services, including the performance of our staff.
2. WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOUR CHILD FOR OTHER SPECIFIC PURPOSES
Facility Directory: Unless you object, we will include certain limited information about your child in our facility directory. This information may include your child’s name, your child’s location in the facility, your child’s general condition, and your child’s religious affiliation. Our directory does not include specific medical information about your child. We may release information in our directory, except for your child’s religious affiliation, to people who ask for your child by name. We may provide the directory information, including your child’s religious affiliation, to any member of the clergy.
Individuals Involved in Y our Child’s Care or Payment f or Your Child’s Care : Unless you object, we may disclose your child’s protected health information to a family member or close personal friend, including clergy, who is involved in your child’s care.
Disaster Relief: Unless you object, we may disclose your child’s protected health information to an organization assisting in disaster relief efforts.
As Required by Law: We will disclose your child’s protected health information for public health activities. These activities may include:
- reporting to a public health or other government authority for preventing or controlling disease, injury, or disability, or reporting child abuse or neglect;
- reporting to the federal Food and Drug Administration (FDA) concerning adverse drug events or problems with products for tracking products in certain circumstances, to enable product recalls, or to comply with other FDA requirements;
- to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; or
- for certain purposes involving workplace illness or injuries
Reporting Victims of Abuse, Neglect, Exploitation, Misappropriation of Property or Domestic Violence: If we believe that your child has been a victim of abuse, neglect, exploitation, misappropriation of property or domestic violence, we may use and disclose your child’s protected health information to notify a government authority if required or authorized by law.
Health Oversight Activities: We may disclose your child’s protected health information to a health oversight agency for activities authorized by law. These may include, for example, government audits, investigations, surveys, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment or regulatory programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings: We may disclose your child’s protected health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts will be made to contact you about the request or to obtain an order or agreement protecting the information.
Law Enforcement: We may disclose your child’s protected health information for certain law enforcement purposes, including:
- as required by law to comply with reporting requirements;
- to comply with a court order, warrant, subpoena, summons, investigative demand or similar legal process;
- to identify or locate a suspect, fugitive, material witness, missing person;
- when information is requested about the victim of a crime if the individual agrees or under other limited circumstances;
- to report information about a suspicious death;
- to provide information about criminal conduct occurring at the facility;
- to report information in emergency circumstances about a crime; or
- where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.
Research: We may allow protected health information of residents from our facility to be used or disclosed for research purposes provided that the research adheres to certain privacy protections. Your child’s health information may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your child’s death, or if you authorize the use/disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations: We may release your child’s protected health information to a coroner, medical examiner, funeral director or, if your child is an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety: We may use or disclose your child’s protected health information when necessary to prevent a serious threat to your child’s health or safety, or the health and safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.
Workers’ Compensation: We may use or disclose your child’s protected health information to comply with laws relating to workers’ compensation or similar programs.
National Security and Intelligence Activities: Protective Services for the President and Others: We may disclose protected health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of state, or to conduct certain special investigations.
Fundraising Activities: We may use certain protected health information to contact you in an effort to raise money for the facility and its operations. For example, we may disclose protected health information to a foundation related to Elizabeth Seton Children’s so that the foundation may contact you in raising money for the facility. In doing so, we would only release contact information, such as your child’s name, address, phone number, and the dates your child received treatment or services at Elizabeth Seton Children’s. Should you choose to opt out of fundraising activities, please email
firstname.lastname@example.org or call (914) 294-6151.
Appointment Reminders: We may use or disclose protected healthinformation to remind you about child’s appointments.
Treatment Alternatives: We may use or disclose protected health information to inform you about treatment alternatives for your child that may be of interest to you.
Health Related Benefits and Services: We may use or disclose protected health information to inform you about health-related benefits and services that may be of interest to you.
3. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PROTECTED HEALTH INFORMATION
We will use and disclose protected health information (other than as described in this Notice or required by law) only with your written authorization. We will not sell or use or disclose your child’s protected health information for marketing purposes without your written authorization. You may revoke this authorization to use or disclose your child’s protected health information any time. If you revoke your authorization, we will no longer use or disclose your child’s protected health information except where we have already relied on the authorization.
4. YOUR RIGHTS REG ARDING YOUR CHILD’S PROTECTED HEALTH INFORMATION
You have the following rights regarding your child’s protected health information:
Right to Request Restrictions: You have the right to request a restriction on our use or disclosure of your child’s protected health information. We will consider your request, but we are not required to agree to the restriction, except as follows: if you ask that we restrict the use or disclosure of your child’s protected health information and (a) the disclosure is to a health plan for purposes of carrying out payment or health care operations (and not for purposes of carrying out treatment), and (b) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full, then we must honor your request. If we do agree to any restriction on our use or disclosure of your child’s protected health information, we will abide by that restriction except in emergency situations. We will not agree to restrict uses or disclosures if those uses or disclosures are required by law.
Right of Access to Protected Health Information: You have the right to request, orally or in writing, your child’s medical or billing records or other written information that may be used to make decisions about your child’s care. We must allow you to inspect your child’s records within 24 hours of your request. Release of information requests shall be processed (or requesting party contacted) within 30 days of receipt. We may charge a reasonable fee; [cost of copying (including supplies and labor and postage) for paper records] but no more than $0.75 per page for copying and mailing your requested information.
If we maintain an electronic health record for your child, then you have the right, at your option, to access to the information in electronic format provided to you directly, or to an individual whom you clearly, conspicuously and specifically designate. For information provided to you in electronic format, Elizabeth Seton Children’s will charge a fee that is no greater than the labor costs in responding to your request.
We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to your child’s protected health information, in some cases you have a right to request a review of the denial. This review would be performed by a licensed health care professional designated by the facility who did not participate in the decision to deny.
Right to Request Amendment: You have the right to request the facility to amend any of your child’s health information maintained by Elizabeth Seton Children’s for as long as the information is kept by or for the facility. Your request must be made in writing and must state the reason for the requested amendment.
We may deny your request for amendment if the information:
- was not created by the facility;
- the originator of the information is no longer available to act on your request;
- is not part of the protected health information maintained by or for the facility;
- is not part of the information which you have a right to access; or
- is already accurate and complete, as determined by the facility.
If we deny your request for amendment, we will give you a written denial including the reason for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures: You have the right to request an “accounting” of our disclosures of your child’s protected health information. This is a listing of certain disclosures of your child’s protected health information made by the facility or by others on our behalf, but does not include disclosures for treatment, payment, and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit in writing, stating a time period beginning after April 13, 2003 that is within six (6) years from the date of your request. An accounting will include, if requested:
- the disclosure date;
- the name of the person or entity that received the information and address, if known;
- a brief description of the information disclosed;
- a brief statement of the purpose of the disclosure or a copy of the authorization or request; or
- certain summary information concerning multiple similar disclosures.
The first accounting provided within a 12-month period will be free; for further requests, we will charge you our costs
Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time.
Right to Request Confidential Communications: You have the right to request that we communicate with you concerning your child’s personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests. Your request to confidential communication must be submitted in writing.
Your Rights of Notification in the Event of a Breach: A breach is the unauthorized acquisition, access, use or disclosure of unsecured protected health information. Unsecured protected health information means information that is usable, readable, or decipherable to unauthorized individuals. You have a right to be notified in the event of a breach of your child’s unsecured protected health information, unless we determine that there is a low probability that the information has been compromised. In the event of a breach requiring notification, the notice will be mailed to you as soon as reasonably possible and in no event later than 60 days after we discover the breach, unless we are asked to delay such notice by law enforcement officials.
If you believe that your child’s privacy rights have been violated, you may file a complaint in writing with the facility or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with the facility, contact:
Elizabeth Seton Children’s Privacy Officer
Phone Number: (914) 294-6151
6. CHANGES TO THIS NOTICE
We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in the Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all protected health information already received and maintained by the facility as well as for all protected health information we receive in the future. We will post a copy of the current Notice in the facility.
7. FOR FURTHER INFORMATION
If you have any questions about this notice or would like further information concerning your child’s privacy rights please contact:
Elizabeth Seton Children’s Privacy Officer
Phone Number: (914) 294-6151
Do you have any questions?
Please contact us at 1 (833) 63-SETON